CS000000-A | 09/27/21

COVID-19 State of Vaccine 

Confidence Insights Report

Report 15 | September 27, 2021 | Date Range: August 31 – September 13, 2021

Summary

Findings. Consumer and media interest in vaccination requirements increased significantly following President Biden’s 

announcement of a COVID-19 action plan to boost vaccination rates on September 9, 2021. Some consumers and news outlets 

defended the announcement, highlighting that vaccination requirements are not new; some even wished the requirements 

applied to more people. Other consumers reacted negatively, telling others “#DoNotComply” and claiming that vaccination 

requirements are authoritarian, illegal, and an attack on their personal freedoms. Some consumers expressed confusion and 

frustration with the effectiveness of the vaccines to decrease the spread of COVID-19 and protect against severe COVID-19 

symptoms. Some social media users and news releases continued to pose questions about the strength of natural immunity 

or promoted the idea that natural immunity is superior to vaccine-mediated immunity. Social media users expressed 

disappointment and belief that the United States has not, and will not, contain the COVID-19 outbreak.

Ways to take action. Federal, state, and local partners should continue to work together to explain the rationale for updated 

guidance, respond to gaps in information, and confront misinformation with evidence-based messaging. The goal of these 

efforts is to increase confidence in COVID-19 vaccines and expand vaccine uptake. Clarify the parameters of the vaccination 

requirements and testing requirements for the President’s COVID-19 action plan. Assist consumers and employers in 

determining whether the vaccination requirements apply to them, provide more information about getting exemptions and 

verifying vaccination, and enact weekly testing protocols. Consumers continued to inquire about the payment process after 

receiving a bill for vaccination or being asked for their insurance.

Contents

2 Aims and Methods

3 Some consumers sought clarity about vaccination requirements, 

while others planned to resist requirements.

4 Consumers are confused, frustrated, and angry with the state of the 

pandemic and the country’s response to it.

5 Continuing and Evolving Themes

6 Appendix: Inputs and Sources

Centers for Disease Control & Prevention, 

COVID-19 Response, Vaccine Task Force

Vaccine Confidence & Demand Team, Insights Unit

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).
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COVID-19 State of Vaccine Confidence Insights Report | Report 15 | September 27, 2021

Aims and Methods

By rapidly reviewing and analyzing numerous sources and inputs (see Appendix), the biweekly COVID-19 State of Vaccine 

Confidence Insights Report emphasizes major themes influencing COVID-19 vaccine hesitancy and uptake. These are 

characterized by the level and type of threat to vaccine confidence, degree of spread, and directionality. In addition, by 

examining how consumers think and feel, social processes, and the practical issues around vaccination, the Insights Report 

seeks to identify emerging issues of misinformation, disinformation, and places where intervention efforts can improve vaccine 

confidence across the United States.

The information in this report is only a snapshot, and certain populations may be underrepresented. Images and quotes are 

illustrative examples and are not meant to comprehensively cover all content related to the highlighted themes. 

Theme Classification

How do you classify this theme/information? 

High risk Moderate risk Low risk Positive sentiment

 May lead to vaccine 

refusals and decreased 

uptake 

 Wide reach, pervasive  

 Potential to trigger 

hesitancy to vaccination

 Moderate reach, modest 

dissemination 

 Concerning, but low risk 

to vaccine confidence 

 Limited reach, limited 

dissemination 

 Could increase vaccine 

confidence, intent, or 

motivation

 Variable reach and 

dissemination

How has this theme/idea changed over time (since last report or over the course of multiple reports)? 

Increasing

Information spreading rapidly 

Stable

Information remaining 

constant at prior level 

Decreasing

Information is not gaining further 

traction and there has been no 

indication of additional activity 
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COVID-19 State of Vaccine Confidence Insights Report | Report 15 | September 27, 2021

Major Themes

Some consumers sought clarity about vaccination requirements, while others 

planned to resist requirements. 

Consumer and media interest in vaccination requirements increased following the September 9, 2021 announcement of 

President Biden’s COVID-19 action plan to boost vaccination rates.a,1,2

 Reports of states, jurisdictions, and employers’ discussing, 

planning and implementing vaccination requirements, including requirements for school-aged adolescents, drove interest in 

requirements.3,4,5

 Many consumers sought clarity about the announcement, questioning who must be vaccinated, especially 

how President Biden’s executive order to boost vaccination rates relates to federal employees and elected officials. 6,7,8

Some consumers and news outlets defended the announcement, highlighting that vaccination requirements are not new;9,10

some even wished the requirements applied to more people.11,12,13 Additionally, some recent polls showed that support for 

vaccination requirements is rising, with the majority of consumers surveyed indicating they support these requirements.14,15,16

Other consumers reacted negatively, telling others “#DoNotComply” 

and claiming that vaccination requirements are authoritarian, 

illegal, and an attack on their personal freedoms.17,18,19,20,21 Some 

state and jurisdictional political leaders challenged the President’s 

plan – questioning the legality of requirements, halting the 

implementation in some areas, and calling for consumers to not 

follow requirements,22,23,24,25,26 despite assurances from some federal 

leaders that requirements are both “legal and appropriate.”27,28,29,30,31,32

Some politicians and consumers expressed concern that these 

requirements would lead to workers’ resignation or termination, 

further exacerbating the labor shortage.33,34,35,36,37,38 This is alongside 

multiple reports of essential workers resisting requirements.39,40,41

In fact, in Florida, fines are now being levied against businesses with proof of vaccination requirements.42,43,44 Questions of 

necessity for requirements by some consumers and politicians also arose, especially for people who are working remotely or 

who previously had a COVID-19 diagnosis.45,46,47,48 While some consumers felt the required weekly testing was an acceptable 

alternative to the vaccination requirement,49 others questioned the feasibility of such testing and perceived it as insufficient to 

prevent the spread of COVID-19.50,51,52

Consumers who are unvaccinated sought ways around the vaccination requirements. Consumers increasingly searched online 

for information and inquired about exemptions to requirements.a,b Religious exemptions were of particular interest,53,54with 

some groups even helping consumers navigate the exemption process.55 However, reports surfaced across the country of 

employers denying exemption requests,56 with some employers placing people on unpaid leave until the employee gets either 

an exemption or vaccinated.57 Additionally, news reports increased about people using or selling fake COVID-19 vaccination 

cards.58,59,60,61,62

Ways to act:

 Clarify the parameters of the vaccination requirements and testing requirements for the President’s COVID-19 action plan. 

 Assist consumers and employers in determining whether the vaccination requirements apply to them, provide more 

information about getting exemptions and verifying vaccination, and enact weekly testing protocols.

 Disseminate messages about the role of vaccination requirements for other vaccine-preventable diseases, including how they 

worked, how they have typically been used, and how they have helped reduce the burden of vaccine-preventable diseases.

 Partner with state, jurisdictional, and local health departments to support employers in promoting and adhering to 

vaccination requirements, including providing communication and outreach tools to increase vaccination confidence and 

access to vaccination.

 Document and share lessons learned from state and local efforts with vaccine verification systems that are in use.

a

CDC-INFO

b

Google Trends
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COVID-19 State of Vaccine Confidence Insights Report | Report 15 | September 27, 2021

Consumers are confused, frustrated, and angry with the state of the pandemic and 

the country’s response to it. 

Some consumers expressed confusion and frustration with the effectiveness of the vaccines to decrease the spread of COVID-19 

and protect against severe COVID-19 symptoms.63,64,65,66,67,68,69 Some social media users and vocal vaccine deniers used the 

perceived low COVID-19 vaccine effectiveness to question the need for vaccine requirements.70,71,72,73

As news outlets and scientific publications continued to report on COVID-19 breakthrough cases, hospitalizations, and 

deaths,74,75,76 some consumers expressed their belief that organizations are skewing the numbers to support vaccination. 77,78,79

Some social media users and news releases continued to pose questions about the strength of natural immunity c,80,81,82,83,84,85or 

promoted the idea that natural immunity is superior to vaccine-mediated immunity. 

d,86,87,88,89,90,91,92,93 An Israeli preprint study, which appears as the top result when 

searching Google with terms related to “natural immunity versus a vaccine,” drove 

some of this discussion.d,94,95,96,97,98Additionally, “natural immunity to covid vs vaccine 

immunity” appeared as rising search terms several times during this reporting period, 

mostly on YouTube.e

 More generally, from September 9 to September 15, searches of 

natural immunity on CDC.gov increased 59% compared to the previous week.f

 This 

may be related to the White House’s announcement about vaccine requirements.

Social media users expressed disappointment and belief that the United States has 

not, and will not, contain the COVID-19 outbreak.99,100,101,102,103,104 Some social media 

users conveyed their annoyance with people who are not vaccinated because of 

their role in the continuation of the COVID-19 pandemic.105,106,107,108,109Other social 

media users and vocal vaccine deniers shared their frustration with the perceived 

low effectiveness of the COVID-19 vaccines and with vaccine requirements because 

of the belief that consumers who are vaccinated are spreading COVID-19.110,111,112 A 

recent poll found that 68% of respondents believe the COVID-19 situation is getting 

worse, up from 45% of respondents surveyed in July. Most respondents expected the 

economic and societal disruptions tied to the pandemic to continue beyond the end of this year.113 This sentiment might have 

been reinforced when news outlets reported that a director at the World Health Organization (WHO) said COVID-19 is “here to 

stay with us.” 114,115

Consumers also reported reduced confidence in public health officials and 

COVID-19 vaccines. A recent poll found that 37% of U.S. adults believe public 

health officials falsified the safety of COVID-19 vaccines, up from 32% in early 

July, while 19% are not sure.116 Another poll found that 44% of respondents 

who are unvaccinated reported their most important reason for not getting 

vaccinated is that they do not trust the vaccine.117

During this reporting period, consumers and news outlets increasingly 

talked about the B.1.621 variant (i.e., Mu variant). With WHO’s announcement 

that they are monitoring the Mu variant,118news outlets began reporting on 

the new variant.119,120,121,122,123,124 From September 2 to September 8, “mu variant” was the top search term on CDC.gov.g

Ways to act:

 Disseminate messages to build confidence that the country and the world will successfully manage the pandemic by 

highlighting what has been accomplished so far. However, consider reframing current messages that suggest community 

mitigation and vaccination will end the COVID-19 outbreak. Continue communicating what is known and not known about 

COVID-19 outbreak and mitigation tools.

 Engage trusted and new partners to disseminate and amplify these messages.

 Create messaging explaining the limitations of preprint studies as well as their beneficial role in the scientific process.

c

CDC-INFO

d

SEMrush

e

Google Trends

f

CDC website metrics

g

SEMrush
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COVID-19 State of Vaccine Confidence Insights Report | Report 15 | September 27, 2021

Continuing and Evolving Themes 

The themes below have been noted in previous reports and continue to undermine vaccine confidence. The information 

highlighted below focuses on what is new or different from earlier reports. For additional context and previous 

recommendations on these themes, see previous Insights Reports.

Brand Preferences. News coverage and online conversations about the Moderna COVID-19 vaccine increased, mostly driven 

by reports of high efficacy against the Delta variant125,126,127 and speculation on when it might receive full FDA approval.128,129

Some consumers expressed a desire to receive the Moderna vaccine for a booster dose if it becomes available, even if they 

received a different brand for their primary series,130 despite limited data available on Moderna boosters to promote their 

necessity.131,132,133,134 Meanwhile, news outlets and some social media 

users discussed reports of deaths resulting from contaminated Moderna 

COVID-19 vaccines, leading to its recall in Japan.135,136,137,138 

Fertility. Consumers continued to show concern about the potential 

impact of COVID-19 vaccines on reproductive health on social 

media.139,140,141,142 Concerns about the effects of vaccination on male 

fertility specifically increased after claims by a celebrity grew widespread. 

Scientists and public health professionals quickly debunked the 

assertion.143,144,145,146,147

Alternative treatments. Ivermectin continued to dominate discussions 

on social media and misinformation outlets while consumers interested 

in the benefits of azithromycin on COVID-19 appeared to increase.148,149,150,151

Advocates of natural cures continue to promote combinations of diet, exercise, 

vitamins, zinc, and other over-the-counter supplements as ways to both prevent and 

cure COVID-19.152,153,154,155,156

Cost. Consumers continued to inquire about the payment process after receiving 

a bill for vaccination or being asked for their insurance.h,157 This has surprised and 

disheartened consumers because they understood vaccinations to be administered 

free of charge.

Booster doses. Consumers continued to discuss the necessity and timeline of the 

booster dose program in the United States,157,158,159,160,161,162 with one recent poll 

finding that consumer who are vaccinated desire booster doses.163 The resignation 

of two Food and Drug Administration officials caught media attention and indicated 

the politicization of the vaccine authorization and approval process for some 

consumers.164,165,166,167

h

CDC-INFO
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COVID-19 State of Vaccine Confidence Insights Report | Report 15 | September 27, 2021

Appendix: Inputs and Sources

Type Input Cadence Sources Tactics for Utilization

Social Media 

Listening 

& Media 

Monitoring

Communication Surveillance 

Report

Daily on 

weekdays

Google news

 Meltwater

CrowdTangle

Native platform searches

 Share of voice topic analysis to identify themes

 Emerging topics 

Meltwater Daily  Facebook, Twitter, Instagram

 Blogs

News media

Online forums

 Share of voice topic analysis

 Emerging theme topics

Identify high reach/velocity topics

Office of the 

Associate Director of 

Communication (OADC) 

Channel COVID-19 Post 

metrics

Weekly  Sprout Social

Native OADC account analytics

 Analyze # of posts, topics 

 Success of messages, # of impressions, reach, # 

engagements

OADC Channel Comment 

Analysis

Daily on 

weekdays

Native platform searches  Sentiment analysis

Identify message gaps/voids

Direct 

Reports

CDC-INFO Metrics Weekly CDC-INFO inquiry line list

 Prepared response (PR) usage report

 Cross-compare PR usage with inquiry theme 

analysis

 Sentiment analysis

Identify information gaps/voids

Vaccine Task Force (VTF) 

Media Requests

Weekly  Media request line list  Leading indicator for news coverage

Identify information gaps/voids

Web Metrics Weekly  Top pages

Google search queries

 Top FAQs

 Referring domains

Identify information gaps/voids,

Identify keywords/search terms, changes in web 

traffic

Research

Poll Review Weekly Harris Poll, PEW research, Gallup Poll, 

KFF 

New data related to vaccine 

hesitancy

Identify socio-behavior indicators related to 

motivation and intention to vaccinate 

Literature Review Weekly  PubMed, LitCovid, ProQuest Central 

New data related to vaccine 

hesitancy

Identify current vaccination intention

Identify barriers to vaccination

Third Party 

Reports

Tanaq Social Listening 

+Media Monitoring Report

Weekly  Meltwater

 Sprout Social

 First Draft

Native platform searches

 Trending topics

Demographic and geographic conversation 

monitoring

CrowdTangle content 

insights report

Biweekly  Facebook  Top pages (voices), groups

General trends/sentiment analysis

News analysis through posts

First Draft News Vaccine 

Misinformation Insights 

Report

Monthly  Proprietary methods  Media trends analysis

 Emerging threats and data deficits

Online vaccine narratives

Project VCTR Weekly  Proprietary methods National and regional trends in negative 

attitudes toward vaccination

Conversations around Legislation

Virality Project Weekly  Proprietary methods  Mis- and disinformation trends related to 

COVID-19 vaccine